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Block 3 physiology > Hyperlipidemia and Lipid Assessment > Flashcards

Hyperlipidemia and Lipid Assessment Flashcards

1
Q

What kind of lipids are transported as lipoproteins?

A

blood lipids

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2
Q

What is in the hydrophobic core?

A
  • cholesterol esters

- triglycerides

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3
Q

What is on the hydrophilic surface?

A
  • cholesterol
  • phospholipids
  • apolipoproteins
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4
Q

5 major classes of lipoproteins

A
  • chylomicrons
  • VLDL
  • IDL
  • LDL
  • HDL
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5
Q

chylomicrons - % lipid vs % protein

A

99:1

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6
Q

VLDL - % lipid vs % protein

A

92:8

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7
Q

IDL - % lipid vs % protein

A

85:15

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8
Q

LDL - % lipid vs % protein

A

80:20

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9
Q

HDL - % lipid vs % protein

A

50:50

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10
Q

Very large lipoprotein particles that carrying mainly triglycerides (much lesser amounts of cholesterol and phospholipids)

A

chylomicrons

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11
Q

proteins in chylomicrons

A
  • major: apolipoprotein (apo) B-48

- others: apologetics’s A, C, E

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12
Q

Chylomicrons are formed by _______ _______ cells postprandially from dietary ____, secreted into the intestinal _____ and eventually to the blood through the ______ ______.

A

Chylomicrons are formed by the intestinal epithelial cells postprandially from dietary fats, secreted into intestinal lymph and eventually to the blood through the thoracic duct.

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13
Q

Chylomicrons: Upon delivery to ______ ________ cells, ______ are broken down by ______ _____ to release ____ _____ ____, which are taken up by tissues.

A

Upon delivery to vascular endothelial cells, triglycerides are rapidly broken down by lipoprotein lipase to release free fatty acids (FFA), which are taken up by tissues.

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14
Q

Chylomicrons: The resulting particle, a chylomicron _____, is removed from circulation by ______ receptors.

A

The resulting particle, a chylomicron remnant, is removed from circulation by hepatic receptors.

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15
Q

Contain a large amount of triglycerides and smaller amounts of cholesterol (free and ester forms) and phospholipids

A

VLDLs

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16
Q

proteins in VLDLs

A
  • major: apo B-100

- other: app E, C

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17
Q

VLDLs are produced by __________ and carry _____ synthesized in the liver.

A

VLDLs are produced by hepatocytes and carry lipids (esp TG) synthesized in the liver.

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18
Q

In the blood, ______ lipase hydrolyzes ______, and the size of the particles is reduced, forming ________ density lipoprotein (__), and after further _______ of triglycerides, forming ____ density lipoprotein (__).

A

In the blood, lipoprotein lipase hydrolyzes triglycerides, and the size of the particles is reduced, forming intermediate density lipoprotein (IDL), and after further hydrolysis of triglycerides, forming low density lipoprotein (LDL).

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19
Q

derived from VLDL

A

LDL

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20
Q

Contain large amounts of cholesterol esters and smaller amounts of free cholesterol, triglycerides and phospholipids

A

LDLs

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21
Q

LDL: Each particle contains one single _________ molecule.

A

LDL: Each particle contains one single apo B-100 molecule.

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22
Q

LDL is the main carrier of ______ in blood, transports cholesterol _____ tissues

A

LDL is the main carrier of cholesterol in blood, transports cholesterol towards tissues

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23
Q

Apo B interacts with specific ____ receptors (Apo-B receptors) located on cell surfaces in many tissues, including the ___, resulting in ______ of LDL particles from the circulation.`

A

Apo B interacts with specific LDL receptors (Apo-B receptors) located on cell surfaces in many tissues, including the liver, resulting in removal of LDL particles from the circulation.

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24
Q

LDL particles with more TG characteristics

A
  • larger, less dense

- less atherogenic

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25
Q

LDL particles with less TG characteristics

A

-“small, dense LDL”

more atherogenic

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26
Q

Formed as a precursor (nascent HDL) in liver and intestine

A

HDL

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27
Q

contains mainly protein and phospholipids

A

“nascent” HDL

28
Q

HDL gains _______ and free _______ from tissues (through the action of lecithin-cholesterol acyl transferase – LCAT), also cholesterol _____ from VLDL (cholesteryl ester transfer protein – CETP), becoming “_____” HDL

A

Gains phospholipids and free cholesterol from tissues (through the action of lecithin-cholesterol acyl transferase – LCAT), also cholesterol esters from VLDL (cholesteryl ester transfer protein – CETP), becoming “mature” HDL

29
Q

primary apolipoproteins in mature HDL

A

apo A-I, A-II and A-IV

30
Q

HDL has an important role in _____ cholesterol transport, i.e., carrying cholesterol from ______ tissues back to the _____ for excretion as ____ acids and bile _______.

A

HDL has an important role in reverse cholesterol transport, i.e., carrying cholesterol from peripheral tissues back to the liver for excretion as bile acids and bile cholesterol.

31
Q

lipid profile/panel

A
  • total cholesterol (TC)
  • triglycerides (TG)
  • lipoproteins - HDL-C, LDL-C, VLDL-C
32
Q

Measure actual amount of triglycerides in the _______

A

Measure actual amount of triglycerides in the specimen

33
Q

necessary for differentiating between TG in chylomicron (diet) vs. VLDL (liver)

A

fasting specimen - 12 hours optimal

34
Q

______ has minor effects on cholesterol measurement but normally results in ________ depletion (eliminates postprandial TG)

A

Fasting has minor effects on cholesterol measurement but normally results in chylomicron depletion (eliminates postprandial TG).

35
Q

indicator of metabolic syndrom

A

triglycerides

36
Q

Use as an independent CHD risk factor is controversial

A

triglycerides

37
Q

Increased risk for _____ _________ at levels > 400 mg/dL (most significant > 1000 mg/dL)

A

Increased risk for acute pancreatitis at levels > 400 mg/dL (most significant > 1000 mg/dL)

38
Q

Causes of elevated TGs

A
  • obese/overweight
  • physical inactivity
  • cigarette smoking
  • excessive alcohol intake
  • high carb diets (esp simple)
  • various diseases i.e. T2DM, renal failure
  • drugs i.e. estrogens, corticosteriods
  • genetic dyslipidemia
39
Q

What causes of elevated TBs can lifestyle modification target?

A
  • obese/overweight
  • physical inactivity
  • cigarette smoking
  • excessive alcohol intake
  • high carb diets (esp simple)
40
Q

Assessment of cholesterol from all lipoprotein forms (chylomicron, VLDL, LDL, HDL) – measure actual amount

A

total cholesterol

41
Q

TG > _____ mg/dL (from chylomicrons or VLDL) reduces accuracy of ___ and ____ measurement

A

TG > 400 mg/dL (from chylomicrons or VLDL) reduces accuracy of LDL and VLDL measurement

42
Q

how is HCL assessed

A

like total cholesterol, HDL is measure

43
Q

HDL measurement: ____ and _____ are precipitated, leaving HDL as the only ______-containing lipoprotein (i.e., the profile measures total and HDL cholesterol)

A

HDL measurement: LDL and VLDL are precipitated, leaving HDL as the only cholesterol-containing lipoprotein (i.e., the profile measures total and HDL cholesterol)

44
Q

how are LDL and VLDL assessed

A

calculated values

45
Q

LDL calculation

A

LDL-C = (TC) – (HDL-C) – (TG/5)

46
Q

VLDL calculation

A

VLDL-C = TG/5

47
Q

non-HDL goal

A

Non-HDL-C goal: LDL-C goal + 30 mg/dl

48
Q

causes of low HDL

A

-Elevated triglycerides
-Overweight and obesity
-Physical inactivity
Cigarette smoking
-Very high carbohydrate intake
-Type II diabetes
-Certain medications (e.g., beta-blockers, anabolic steroids, progestational agents)

49
Q

primary cause of hyperlipidemia

A

hereditary

50
Q

secondary causes of hyperlipidemia

A
  • Obesity
  • High calorie diet
  • High TG and saturated fat diets (increases cholesterol synthesis)
  • ↑ VLDL production (high refined carbohydrate diet)
  • Sedentary lifestyle
  • Diabetes
  • Other such as hypothyroidism, medications
51
Q

Fredrickson Classification of Primary Hyperlipidemias: Type 1

A
  • creamy top
  • chylomicrons
  • Lipoprotein lipase deficiency, Apo-C2 deficiency
  • serum TC normal
  • serum TG elevated ++
52
Q

Fredrickson Classification of Primary Hyperlipidemias: Type 2a

A
  • clear
  • LDL
  • Familial hypercholesterolemia, Polygenic hypercholesterolemia, Familial combined hyperlipidemia
  • serum TC elevated ++
  • serum TG normal
53
Q

Fredrickson Classification of Primary Hyperlipidemias: Type 2b

A
  • clear
  • LDL, VLDL
  • Familial combined hyperlipidemia
  • serum TC elevated ++
  • serum TG elevated +
54
Q

Fredrickson Classification of Primary Hyperlipidemias: Type III

A
  • turbid
  • IDL
  • Familial dysbetalipoproteinemia
  • serum TC elevated +
  • serum TG elevated +
55
Q

Fredrickson Classification of Primary Hyperlipidemias: Type IV

A
  • turbid
  • VLDL
  • Familial hypertriglyceridemia, Familial combined hyperlipidemia, Sporadic hypertriglyceridemia,
  • Diabetes*
  • serum TC normal/elevated +
  • serum TG elevated ++
56
Q

Fredrickson Classification of Primary Hyperlipidemias: Type V

A
  • creamy top, turbid below
  • chylomicrons, VLDL
  • Diabetes
  • serum TC elevated +
  • serum TG elevated +
57
Q

Mutation in LDL receptor preventing LDL uptake, resulting in elevated LDL levels at birth and throughout life

A

familial hypercholesterolemia (type IIa)

58
Q

Co-dominant genetic disorder, both heterozygotes (1/500) and homozygotes (1/1M) are affected

A

familial hypercholesterolemia (type IIa)

59
Q
  • Increased production of VLDL and LDL

- Elevated cholesterol and triglycerides

A

Familial combined hyperlipidemia (type IIb)

60
Q

Autosomal dominant (1/50 to 1/100), unknown etiology

A

Familial combined hyperlipidemia (type IIb)

61
Q
  • Results from impaired chylomicron and VLDL clearance

- High chylomicrons and VLDL, increased TC and TG

A

Familial dysbetalipoproteinemia (type III)

62
Q
  • Multiple defects, varying inheritance patterns

- Exacerbated by obesity, diabetes, hypothyroidism, alcohol, chronic kidney disease

A

Familial dysbetalipoproteinemia (type III)

63
Q
  • Increased VLDL

- Elevated TG

A

Familial hypertriglyceridemia (type IV)

64
Q
  • Autosomal dominant (1/100), clearance defects

- Associated with insulin resistance

A

Familial hypertriglyceridemia (type IV)

65
Q

hyperlipidemia risks: elevated cholesterol, especially high LDL and reduced HDL

A
  • atherosclerosis

- xanthomas and xanthelasmas

66
Q

collections of foam cells (cholesterol) - larger and in skin, tendons

A

xanthomas

67
Q

collections of foam cells (cholesterol), smaller and generally on the face esp around eyes

A

xanthelomas

Block 3 physiology (6 decks)

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